Sifting through health insurance options

[FireAnt]

I am getting overwhelmed trying to choose health insurance options and hoping to get some insight from someone with fresh eyes and/or someone who may have a better understanding.

My husband is leaving his toxic job at the end of the year. He is going to take a few months off and see if he can really make a project of his profitable. If not, he will look for another job with a hopefully healthier work culture. I am a travel healthcare worker so I've been working full time for part of the year, then work per diem part time over the summer while at my home base.

We are very healthy and rarely utilize the deductible. Often times we just use the fully covered preventative yearly check up. We have been maxing out our HSA for the last several years since starting our FIRE journey.

Options:
1. My travel agency/employer offers health insurance for $40/week individual and $102/week family with a small HSA contribution ($10/week individual, $20 family). $3000/$6000 deductible. The con is that after I end my contract (estimate end of April) we won't have coverage and to start another plan would reset our deductibles.

2. We have called two different insurance brokers who both gave similar quotes for about $440/month for a PPO with $5000 deductible. No HSA. Both have really pushed us away from ACA when asked. One stating that it wouldn't cover across state lines unless it's a true life or death emergency. The other one said that there is ED coverage but "No out of pocket max".

Interestingly, it says the following at the end "These plans are exempt from the requirements of the Aordable Care Act (“ACA”), do not qualify as ”minimum essential coverage” under the ACA, and they do not provide coverage for all ten (10) ”essential health benefits” under the ACA. B"

3. I went through the ACA application to get an idea of coverage for both of us. Qualified for $144 subsidy through spouse only, but the plans are outrageously expensive. For the same price above, the deductibles are in the $17000 range. I had to take my best guess for incomes since both of ours are very varied/unknown.

What else should I be exploring/considering? Should we just have separate insurances? We've been so lucky to have good health insurance with little to no premiums so this all seems like a lot to me to me and overwhelming. Also, it should not be this damn complicated.

[alcon835]

You're not getting any replies here, so I thought I'd help you bump the thread a bit. I don't know a lot about what you're looking at going forward, but I would seriously question the ACA doesn't work across state lines thing. I'd look into that aggressively.

For the Insurance Brokers, how can they not cover all the essential health benefits? Are you looking at traditional insurance or some sort of medi-share? If the later, then that makes sense, they don't have to cover you the same way traditional insurance does.

If you have the cash and the insurance covers everything you need, based solely on your comments above, I would lean option 2 - only so you can keep it after April. Lack of an HSA may be a deal killer if you need the tax help.

Sorry that I don't have much to offer here. Hoping a little bump will get folks making comments, but I haven't had to debate between ACA vs. other options in almost 8 years.

[SailingOnASmallSailboat]

You're not getting any replies here, so I thought I'd help you bump the thread a bit. I don't know a lot about what you're looking at going forward, but I would seriously question the ACA doesn't work across state lines thing. I'd look into that aggressively.

For the Insurance Brokers, how can they not cover all the essential health benefits? Are you looking at traditional insurance or some sort of medi-share? If the later, then that makes sense, they don't have to cover you the same way traditional insurance does.

If you have the cash and the insurance covers everything you need, based solely on your comments above, I would lean option 2 - only so you can keep it after April. Lack of an HSA may be a deal killer if you need the tax help.

Sorry that I don't have much to offer here. Hoping a little bump will get folks making comments, but I haven't had to debate between ACA vs. other options in almost 8 years.

I think this depends wildly on what state and what plan. I know in Virginia, if we'd gone with a reasonably priced plan, there were no in-network providers even the next county over (other than emergency, which had the general 50% copay and who the heck knows how the hospital and doc thing would work out.) And plans varied HUGELY, both in terms of costs as well as robustness, depending on the county we were choosing. In Vermont, we went with a BCBS plan that has in-network all over the US. We have friends who are ACA in Florida and they note that they have no in-network options once they leave the state (again other than emergencies).

[Sibley]

The non-ACA plans are probably not comprehensive insurance. ACA, when it was passed, pissed off the insurance companies because it forced them to do things like cover pre-existing conditions, pregnancy, mental health, and not cut you off just because you had a really expensive problem like cancer. You know, little things. (/s if you missed the sarcasm) Thus if it's not in compliance with ACA, I'd be seriously side eyeing it, and if I were considering it anyway I'd be asking why its not in compliance, and I'd want to know the details of why.

Your problem is that you're traveling for work. If that wasn't a factor, then ACA is fine. If you get sick or hurt while you're out of state, I believe the ACA plans will cover emergency care. Either that or you go home to see the doctor. But I don't have direct experience. You might get some good info if you can find a group of travelers and ask them what they're doing.

The brokers are discouraging ACA in part because they get paid more if you go through them. They're biased.

As for the ACA plans, are you looking at bronze, silver or gold plans? There is a cost difference. Based on what you say your usage is, you don't need a gold plan. You could probably get away with a bronze plan, though you would have more coverage under a silver. And by coverage, I mean financial coverage. What's covered/not covered medically is going to be fairly consistent.

It sounds like you you make too much to get much subsidy. It's a failing of ACA.

The health shares that are out there are not insurance. They may masquerade as insurance, but they're not legally insurance. So approach those with caution. There was a post quite recently about this, and that person basically got told by everyone that they didn't have insurance.

Going through your current agency might be the most cost effective option, at least for now. You would be eligible to sign up for ACA when you lost your insurance through the agency. And resetting your deductible, while not fun, also doesn't sound like a burden in your situation. If you're not hitting your deductible even in total, then it doesn't really matter if it's split up between plans.

[sonofsven]

On option 1, why are you concerned about re-setting the deductibles when you don't normally fill the deductible?
Besides, if your HSA is really stacked then you should have plenty to pay for medical care until the deductible is filled.
Also, as you may know you don't qualify for ACA if you have a work offered plan, but leaving your job would qualify you for an ACA plan through a special enrollment period, I think that's what they call it. Just FYI.

[ltt]

I am getting overwhelmed trying to choose health insurance options and hoping to get some insight from someone with fresh eyes and/or someone who may have a better understanding.

My husband is leaving his toxic job at the end of the year. He is going to take a few months off and see if he can really make a project of his profitable. If not, he will look for another job with a hopefully healthier work culture. I am a travel healthcare worker so I've been working full time for part of the year, then work per diem part time over the summer while at my home base.

We are very healthy and rarely utilize the deductible. Often times we just use the fully covered preventative yearly check up. We have been maxing out our HSA for the last several years since starting our FIRE journey.

Options:
1. My travel agency/employer offers health insurance for $40/week individual and $102/week family with a small HSA contribution ($10/week individual, $20 family). $3000/$6000 deductible. The con is that after I end my contract (estimate end of April) we won't have coverage and to start another plan would reset our deductibles.

2. We have called two different insurance brokers who both gave similar quotes for about $440/month for a PPO with $5000 deductible. No HSA. Both have really pushed us away from ACA when asked. One stating that it wouldn't cover across state lines unless it's a true life or death emergency. The other one said that there is ED coverage but "No out of pocket max".

Interestingly, it says the following at the end "These plans are exempt from the requirements of the Aordable Care Act (“ACA”), do not qualify as ”minimum essential coverage” under the ACA, and they do not provide coverage for all ten (10) ”essential health benefits” under the ACA. B"

3. I went through the ACA application to get an idea of coverage for both of us. Qualified for $144 subsidy through spouse only, but the plans are outrageously expensive. For the same price above, the deductibles are in the $17000 range. I had to take my best guess for incomes since both of ours are very varied/unknown.

What else should I be exploring/considering? Should we just have separate insurances? We've been so lucky to have good health insurance with little to no premiums so this all seems like a lot to me to me and overwhelming. Also, it should not be this damn complicated.

Please don't assume because you are healthy now that you will stay that way.  All it takes is one bad car accident or illness or fall to have things go bad very quickly.

1.  Can your husband go on COBRA?  As he is quitting the end of the year, am assuming he will be offered it.  It is kind of expensive and he would have to enroll in it.  It would be the same coverage that he currently has, but at least it could bridge him over until his next job.  I'm going to assume that if your husband were to go on COBRA, that the premium for him alone would be up to $1,000 or so per month.  If it's decided that he takes COBRA coverage, you will have to check if you can pay the premiums with the HSA you or he currently have.

2.  The brokers are probably going to make commission on selling you those policies and, thereby, are steering you away from ACA policies.  And they mentioned that there's no out-of-pocket max, yikes!!  Yes, ACA covers you for a specific region, so if you are going to travel, you would need some type of travel medical policy.  Our ACA policy will only cover us for emergencies if we travel outside of our region.

There is some really good preventive coverage with the ACA plans.  Not so with what you are mentioning.

3.  On the ACA website, you can go through without filling out an application to get an idea of plans.  Then if you decide on a plan, can fill out the application.  The plans can be expensive, and, yes, you will probably pay more out of pocket. There are ACA plans that offer an HSA, if that is something you are interested in.  However, if you've managed to put money aside in an HSA over the past few years, then you probably have enough set aside to cover you in the event where you do reach the max out-of-pocket in case things go wrong.  Also, and this may not apply to you, but we are on an ACA plan, and the prescription coverage is pretty good. 

I agree things should not be so complicated. 

[reeshau]

This doesn't make it easier, but be very wary of "cheaper" insurance--judging only by the premium paid.

WSJ just did an article on some "gotcha" plans:
https://wsj-article-webview-generator-prod.sc.onservo.com/webview/SB11483193960469763283004588238373432789506

The ACA has its problems, but the standard set of coverage was meant to simplify comparisons between plans.  Going outside of that means it is up to you to fully understand your coverage, and judge the plusses and minuses.  That's hard to do if you have not used a lot of healthcare.

Unless you have a strong, health-outcome related reason to do something different, I'd go with ACA as the devil you know.  (Or at least, that someone has laid out for you)

[kms]

I was in a similar boat last year and did some research on this. Personally, I wouldn't touch a non-ACA plan with a 10-foot pole. @Sibley summed it up very elaborately so I am not going to repeat it just know this: non-ACA plans can decline coverage and kick you out whenever they deem appropriate and in their best interest.

ACA plans, in return, can be incredibly expensive depending on state. As a self-employed IT consultant I had ACA coverage from 2016 to 2019, and I watched it get worse and more expensive every year. For a brief period of time in late 2016 and early 2017 my wife and I both had ACA plans until her benefits at work kicked in, and we were paying less for both of us than I would be paying for myself right now, with better benefits and a more extensive network. Long story short: ACA, as great as the idea may be, is seriousy flawed. I am not going to get into how and why but one of the major issues can in fact be out-of-state coverage. None of the ACA plans I had between 2016 and 2019 offered out of state coverage as their networks we all in-state only. I am now on my wife's health insurance. We still pay over $1,000 per month for an HSA HDHP plan for the entire family ($5,000 individual and $10,000 family deductible) but at least we get a decent network.

I believe your best bet would be option 1 with a temporary in-between insurace. You say you leave your job at the end of April, how long until you return and coverage resumes?

[lhamo]

Unless you are in a situation where you regularly split your time between two very distant living situations I don't quite understand all this angsting about ACA plans being restricted to a certain geographical area.

Emergency situations are always covered by the ACA.

If you are travelling short-term and have a minor illness that requires diagnosis, you can be seen at most urgent care places for a modest cost. And many ACA networks now are pushing telehealth options, so you could probably just call in and get whatever prescriptions you might need sent to a pharmacy nearby.

If you move mid-year you can switch to a local ACA plan.  Yes, you lose out on whatever deductibles, etc you might have paid, but you can probably get similar coverage.

[FireAnt]

This is delayed, but want to follow up with a THANK YOU on those that provided input. It was helpful while I was comparing options, specifically some of the red flags on the off-market private insurances. We are going to be a little creative in our approach. We are going separate, where I take the employee sponsored insurance and DH will take the ACA plan without subsidy. Once my contract ends, I will join him and we'll qualify for subsidies until I take another travel contract at least.

@lhamo we would normally be splitting our time, 6 times in our home town in Michigan, and winters somewhere much warmer :)

[Blonde Lawyer]

I know it is too late but I wanted to offer one more potential solution.  This was something I read about a lot on my Crohn's disease forums back in the day so this advice may be outdated.  But, there was a list of part-time employers that offered health benefits at a reasonable cost.  Again, outdated info but I think it included Starbucks, Lowes, Home Depot and PetSmart.  I'm sure there are others.  They are all hiring and desperate for workers so they would probably consider someone who can only work 10 hours or so.  If it saved you over $1000/month in insurance, it would be worth it.  It's funny how healthy people aren't always aware of how crazy the insurance market is.  I remember being at an attorney function and hearing people talk about how they saw another older attorney working at Home Depot and they were so confused because he has a successful practice.  I pointed out that as a solo, he's probably saving a fortune working a bit at Home Depot and not having to buy his own insurance plan.  They had never heard of these part time employers with good benefit plans.  I hope there are still some out there.

[FireAnt]

I know it is too late but I wanted to offer one more potential solution.  This was something I read about a lot on my Crohn's disease forums back in the day so this advice may be outdated.  But, there was a list of part-time employers that offered health benefits at a reasonable cost.  Again, outdated info but I think it included Starbucks, Lowes, Home Depot and PetSmart.  I'm sure there are others.  They are all hiring and desperate for workers so they would probably consider someone who can only work 10 hours or so.  If it saved you over $1000/month in insurance, it would be worth it.  It's funny how healthy people aren't always aware of how crazy the insurance market is.  I remember being at an attorney function and hearing people talk about how they saw another older attorney working at Home Depot and they were so confused because he has a successful practice.  I pointed out that as a solo, he's probably saving a fortune working a bit at Home Depot and not having to buy his own insurance plan.  They had never heard of these part time employers with good benefit plans.  I hope there are still some out there.

I've looked into this option before "for fun" as Barista FIRE is something I would highly consider one day. From what I read the minimum hours are usually 24-25 or so depending on the company. But if it really was 10 hours, I'd totally make my husband sign up haha. But I agree, I really had no idea how expensive health insurance is... we've been spoiled with employers that offer low premiums. We are overall healthy individuals, yet the plans are $500 a month or so which has been a shock.

[meadow lark]

Don’t forget the option of Medicaid.  I’ve been very happy with Medicaid.  I don’t know about MI, but in Louisiana our monthly max income is $2k for 2.  Not asset tested, monthly income based only, and irregular (not every month) income will not make you lose it. 

[FireAnt]

Don’t forget the option of Medicaid.  I’ve been very happy with Medicaid.  I don’t know about MI, but in Louisiana our monthly max income is $2k for 2.  Not asset tested, monthly income based only, and irregular (not every month) income will not make you lose it.

I'd have to look up income limits for Medicaid, but I only it definitely doesn't work beyond state lines from my experience working with Medicaid population in mental health. They are typically treated as "no insurance." I'm hoping I can continue my travel social work gig so at least having emergency healthcare covered is important. We can do preventative stuff when we're home. Great thought to explore though.